Operative Blood Loss and Use of Blood Products after Laparoscopic and Conventional Open Colorectal Operations

Hypothesis: Blood loss, measured by estimated blood loss, drop in hemoglobin levels, and transfusion requirements, is lower in patients undergoing laparoscopic colectomy compared with patients undergoing conventional open colectomy. Design: Case-matched study. Setting: A university hospital. Patients: Patients undergoing laparoscopic colectomy between January 2000 and December 2001 were matched in a prospective database for age, sex, comorbidity, and surgical procedure with patients undergoing open colectomy during the same period. Main Outcome Measures: Estimated blood loss, drop in hemoglobin levels, and transfusion requirements after surgery were compared. Results: One hundred forty-seven patients undergoing the same operation using either an open or laparoscopic approach could be matched for age, sex, and diagnosis related grouping. There was no significant difference in American Society of Anesthesiologists class, body mass index, or preoperative and postoperative hemoglobin levels, but the open colectomy group required significantly more units of blood (P=.003) to maintain similar hemoglobin levels after surgery. Estimated blood loss (P<.001) and the number of patients who received transfusions on the day of surgery (P=.002), during the first 48 hours after surgery (P=.005), and during the entire hospital stay (P=.003) were significantly higher in the open colectomy group. Conclusion: A laparoscopic approach for colorectal surgery led to significantly less blood loss than matched open colectomy cases.